14020078CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10370 PLUM TREE LN CONTRACTOR: ONZO ELECTRIC PERMIT NO: 14020078
OWNER'S NAME: RAJESH KAMATH AND KAVITA NAYAK 310 REDDING RD DATE ISSUED: 02/13/2014
OWNER'S HONE: 5103785471 CAMPBELL, CA 95008 PHONE NO: (408)981-9713
LICENSED CONTRACTOR'S DECLARATION
License Class C lb Lic. # 1
Contractor OWZ..-p tea" L(— Date 2 `I —`t{
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
t I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
and will maintain Worker's Compensation Insurance, as provided for by
M3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source a ulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
"001 V
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1 I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2 I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project (Sec 7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1 I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2 I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3 I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9 18.
Signature Date
BUILDING PERMIT INFO• BLDG F_ ELECT I— PLUMB r—
MECH r RESIDENTIAL F COMMERCIAL
N
JOB DESCRIPTION
UPGRADE (E) ELECTRICAL PANEL FROM I00AMP TO
200AMP, SAME LOCATION
Sq. Ft Floor Area:
APN Number: 31633019 00
Valuation: $2000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D ' M T CALLED INSPECTION.
s Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is installed
without first obtaining an inspection, I agree to remove all new materials for inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California
Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with
the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section
25532(a) should I store or handle hazardous material. Additionally, should I use
equipment or devices which emit hazardous air contaminants as defined by the Bay Area
Air Quality Management District I will maintain compliance with the Cupertino
Municipal Code, Chapter 9.12 a lh,_I alth & Safety Code, Sections 25505, 25533, and
25534. )
Owner or authorized agent: ,--v Dater
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's for
which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
n
GENERAL PERMIT APPLICATION �MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 w �/
(408) 777-3228 • FAX (408) 777-3333 • buildina(ftupertino.org \MMMISC
F-1 W STC! r`LTT A1.M('WT to
MEPMisc.4pp_2011.doc revised 06/21/11
PROSECT ADDRESS N
APN it
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OWNSRNAME 4
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE,�.
I FAX
CONTACT NAME
PHONE
E-MAIL
_
STREET ADDRESSCITY,
STATE, ZIP
FAX
❑ OwNER ❑ OV.'NER-BUIIDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHMCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEOv� Zo 'i—a<G;`
LICC$ENC� ER S
LICENSE TYPE
BUS. LIC#
COMPANY NAME 6� ^
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FAX
STREET ADDRESS --,,, `W C
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I PHONE
ARCHTTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
B -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMMY
PROJECT INWI DLAND ❑ YES
PROJECT IN ❑YES
IS THE BLDG AN [3 YES
[3NO
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME?
DFSCRiPTION OF WORK
TOTAL VALUATION:
b f
By my signature below, I certif§ to each of the following: I am the property owner or authorized agent to act property dimer's behalf. I have read this
application and the information I haver ' correct. I have read the Description of Work and I agree to comply with all applicable local
ordinances and state laws relating to wilding co
. I authorize representatives of Cupertino
to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date: Z � 1
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMisc.4pp_2011.doc revised 06/21/11
�w CITY OF CUPERTINO
F� 1P .F. F.CTIMATOR — RITII,DING DIVISION
ial*ADDRESS: 10370 PLUM TREE LN
FEE ITEMS (Fee Resolution .11-053 ff.' 7.1/13)
DATE: 02/13/2014
REVIEWED BY: MELISSA
APN: 316 33 019
BP#:
'EVALUATION: 1$2,000
PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
PENTAMATION 1 REAP2
USE:
PERMIT TYPE:
WORK
UPGRADE E ELECTRICAL PANEL FROM 100AMP TO 200AMP SAME LOCATION
SCOPE
PME Unit Fee:
$47.00
ce:
3 its -15. Ince d F 2u.
raftvwb
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. Ej hrs $47.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public worms, rrre, Sanitary newer wsrr"t, acnoor
District, etc). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution .11-053 ff.' 7.1/13)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$47.00
PME Permit Fee:
$47.00
i.. fif 4� +._Ar'If� •_..
T7-
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes •, No
$0.00
A
Travel Documentation Fee: ITRA VDOC
$47.00
Strong .Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: I1BCBSC
$1.00
$186.50 $0.00 TOTAL FEE: $186.50
Revised: 01/15/2014